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11010 SW COTTONWOOD LANE
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C� CITY OF T'lO Y 1
OREGON ®�
Bob Smi th
11010 SW Cottonwood Lane it No ��.
• x.472..........
Owner ...
BuildingAddress.. ................. ............. ....................._.........._..._...............................
24th Novamber 1977
Certificate Is terehy given thts.. ............day of....... ......................., ... ......
that said building may be occupied and
" that complies with all requirements o. I
l the Building Code for tY c City of Tigard, lrp
as approved b the Ti card City Council.
iBuilding Inspector I ( Y
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A D D R E S5_ /./6) 0 �tc, PERMIT No._._.� ___. ____.,_._..__._.. .`
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PERMIT CHARGE nnnu
C,1,I N E f2 � � n`' _. .. .__ C O N N E C:T I O N FEE
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PA1D BY
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TYFE OF' BUILDING __. .���' DATE. CONNECTED
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SE: RUICE RATE _�57 __ INSPUTION F E .�__�7_S_._✓ .___ _
COVRAC(OR _ PAID BY � _ DATE
SIZE OF* CONNECTION ASSESSMENT PAID
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City of Tigard V
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INSPECTION REQUEST
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INSPECTION TIME: W4-'v'r' PERMIT NO. :_
DATE: ATE ISSUED : L Z
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OWNERS NAME
ADDRESS: LVZ"
CONTRACTOR :
'EST: Air ❑, Water(] , Visual Q , Laboratory p I
RESULT: Approved Disapproved C Pending p
SKETCH:
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INS#ECTOR DATE
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5�3►-77
SEWER PERMIT =fA
Uf N" 12177
Unified Sewerage Agency
of Washington County CITY OF, Tigard _ DATE May__31, 1977
OWNER Bob Smith PHONE , 644-8955
OWNER 'S ADDRESS: . 9925 S.W, Midea Lane Portland 97225
TYPE OF INSTALLATION:
O BUILDING SEWER ❑BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
XQ NEW X❑ SINGLE FAMILY ❑ cOMMERCIAL
❑EXIST . (PRIOR TO 7-1-70 ) ❑ MUL.T. RES. ❑ I '4DUSTRIAL
FIXTURE UNITS DWELLING UNITS 1_
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLi WITH ALL RULES
AND REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING FOR
INSPECTION, PLEASE REFER TO THE PERMIT NUMBER . THIS APPLICATION
EXPIRES IN ONE-HUNDRED AND TWENTY ( 120 ) DAYS . THE AMOUNT PAID WILL
BE FORFEITED SHOULD EXPIRATIO14 OCCUR .
FEES:
PERMIT FEE S 575
CONNECTION CHARGE 25
SIDE SEWER INSTALLATION JA j (_a11 , 2M _
I SUED BY
OTHER -
TOTAL $
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�, ( �• ---- May 31, 1977 --
• ADPL I CANT DAT[
SEWER PERMIT 1 ' 1 `77
ADDRESS OF STRUCTURE`"/
TAX MAP TAX LOT SYSTEM _
LOT BLOCK OF
APPROVED 6Y+ DATE ISSUED BY DATE
REMARKS
BUILDING PERMIT APPLICATION 1OF
1T TIG ARD DATE fty 31 _ 19 77 1472
THE UNDERSIGNED HEREB" APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONG L_4.,1—:1955
LOT NO.
OWNER t�i. JOe ADDRESS •u • 0L.tU91iWJ:r4bMIk,"bAESS
ARCHITECT
ENGINEER
BUILDER ADDRESS DESIGNER
STRUCTURE ❑NEW ❑_REMODEL ❑ADDITION UREPAIR�- ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
Cl RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO 13CAR PORT ❑GARAGE ❑STOHAGE❑SLAB ❑FENCE
❑BOND ❑MOV ING ❑CONDITIONAL USE ❑DESIGN FIE',IEW ❑COUNCIL APPROVED [:]SIGNS
OCCUPANCY—__LAND USE ZONE— BLDG.TYPE FIRE ZONE— PLAN CHECK BY _ _ HEAT_-_y__
ronstruct a sintIle family home w attechad gegage 4 bedrromn 3 baths —
rdilissus of permit ;`1461 — 11175 50.j. k?uxuoa.d ("to
OCC.LOAp _-_FLOOR_. f3� I�LGFIZ.--__�.1LO,Ur)31E�._.—__.ABE�7 3 NQ����OQMS�VALUE 40 gnt.
BUILDING DEPARTMENTSET BACKS FRONT 20 FILAR 35 LEFT SIDE RIGHT SIDE 11J
Permit r -- — --.—_.�_- --- ---------THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check T U,() REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WIT14 THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Subtotal ALL APPLICABLE fODFS AND ORDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax LICENSE. SEPARATE PERMITS REOUiRED FOR SEWER, PLUMBING AND HEATING,
Total 175.10
BY---.-_— --Jb
APP.LICANt OR AGENT --
Approved ( Receipt No
AD 9 E
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DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor,
Permit No.
Rough-in
Fixture
?_16-1 J1 441A k Final
-- HEATING
Contractor
Permit No.
10 -13-91 Gas or Oil
Rough-in
Final
SEWER
'U.. Final
DRIVEWAY
Final
Storm Drainage
Rain Drain) Final
Sidewalk
Curb&Street Final
Approach
BLDG DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY —
Landscaping
�, Zoning Final